Provider Demographics
NPI:1740635697
Name:CANTWELL, ELIZABETH JUDITH
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:JUDITH
Last Name:CANTWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:JUDITH
Other - Last Name:STRANGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:700 SHORE RD APT 6A
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-4718
Mailing Address - Country:US
Mailing Address - Phone:516-889-0835
Mailing Address - Fax:
Practice Address - Street 1:700 SHORE RD APT 6A
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-4718
Practice Address - Country:US
Practice Address - Phone:516-889-0835
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-28
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY697814174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist